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The Dissociative Mind | 
 enlarge | Author: Elizabeth Howell
Publisher: Routledge
Category: Book
List Price: $34.95
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Avg. Customer Rating:  2 reviews
Sales Rank: 141138
Media: Paperback
Edition: 1
Number Of Items: 1
Pages: 328
Shipping Weight (lbs): 1
Dimensions (in): 8.9 x 6 x 0.9
ISBN: 0881634956
Dewey Decimal Number: 158
EAN: 9780881634952
ASIN: 0881634956
Publication Date: April 10, 2008
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Product Description
Drawing on the pioneering work of Janet, Freud, Sullivan, and Fairbairn and making extensive use of recent literature, Elizabeth Howell develops a comprehensive model of the dissociative mind. Dissociation, for her, suffuses everyday life; it is a relationally structured survival strategy that arises out of the mind?s need to allow interaction with frightening but still urgently needed others. For therapists dissociated self-states are among the everyday fare of clinical work and gain expression in dreams, projective identifications, and enactments. Pathological dissociation, on the other hand, results when the psyche is overwhelmed by trauma and signals the collapse of relationality and an addictive clinging to dissociative solutions.
Howell examines the relationship of segregated models of attachment, disorganized attachment, mentalization, and defensive exclusion to dissociative processes in general and to particular kinds of dissociative solutions. Enactments are reframed as unconscious procedural ways of being with others that often result in segregated systems of attachment. Clinical phenomena associated with splitting are assigned to a model of ?attachment-based dissociation? in which alternating dissociated self-states develop along an axis of relational trauma. Later chapters of the book examine dissociation in relation to pathological narcissism; the creation and reproduction of gender; and psychopathy.
Elegant in conception, thoughtful in tone, broad and deep in clinical applications, Howell takes the reader from neurophysiology to attachment theory to the clinical remediation of trauma states to the reality of evil. It provides a masterful overview of a literature that extends forward to the writings of Bromberg, Stern, Ryle, and others. The capstone of contemporary understandings of dissociation in relation to development and psychopathology, The D
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An outstanding contribution to the literature on dissociative processes April 6, 2008
7 out of 7 found this review helpful
Dear Reader, this is an excerpt, sans introductory paragraphs, of a published review I wrote of Dr. Howell's book in the American Psychological Association Division 56 Newsletter in January 2007. Her book is excellent and "required" reading for anyone seriously interested in understanding dissociative processes.
Howell extensively traces the history of dissociation in psychoanalysis from the seminal work of Janet, through Freud, Ferenczi, Fairbairn, Sullivan, Bromberg, Davies, Frawley-O'Dea, and Donnel Stern over several chapters. She takes great pains to show the specific ways in which earlier psychoanalytic theory was built upon an unacknowledged foundation of dissociative processes. She unearths what is not so deeply buried: Freud borrowed heavily from Janet, Fairbairn built object relations from explorations of the minds of children with dissociative identity disorder, Sullivan's selective inattention referred to dissociative process, and the schizoid personality is also essentially a construct built upon dissociative process. What she shows with clarity, though doesn't specifically state, is that the dissociative mind is an intrapsychic reflection of a dissociative world, a world where, as Stern would have said in regard to his concept of "weak dissociation," effort is required to generate a coherent view of self and other. The world is dissociative? Yes, the world is a collection of snips of experience that flow into each other, but we don't have the capacity to see it all at once. We can take it in as chunks. As Howell points out, a "unitary mind" is a creative bit of illusory self-deception that aids the formation of identity. Howell believes we all have a relationally based mind that must work hard to piece together both internal and external experience into a coherent picture of living. It is in the quality of relating that has been called right-brain to right-brain communications (Schore, 2003) that infants take in the nuances of experience like those described as the "transformational object," the parent who provides what the infant needs as the need arises so that the infant changes state smoothly (Bollas, 1987). Early in her text Howell shows how a multiplicity of theoretical models such as those proposed by Putnam (based upon Wolf's work), discrete behavioral states, and the states of mind model of Daniel Siegel, are part and parcel of more relational psychoanalytic models (Putnam, 1997) (Siegel, 1999). She develops the powerful implications of a psychoanalytic theory based upon organizations of states rather than more traditional structural, ego psychological, or object relational theories. While she credits Davies and Frawley for bringing trauma theory to psychoanalysis (Davies, 1994), Howell's exploration fills in the landscape of that earlier map in great detail and adds territory for additional thought both for psychoanalysts and traumatologists .
Howell completes her review of theoreticians in a discussion not usually emphasized, or even entertained in psychoanalytic or traumatologic literature by looking at the work of Anthony Ryle and Ernst Hilgard. Ryle developed a cognitive analytic therapy (CAT) that focused its attention on the reciprocal role procedure (RRP), a kind of procedural memory that serves as an action script for relationships (Ryle, 1999). Like the internal working models (IWMs) of Bowlby, these implicit action scripts remain outside awareness, isolated from consciousness (dissociated), but nevertheless seeking confirmation/disconfirmation of hypotheses about the self in relation to others that were learned through early relationships. Painful RRPs seek resolution just like any other psychic pain motivates behavioral solutions when there is no explicit knowledge of these RRPs. Developing consciousness for actions scripts, such as feelings of being deprived and seeing others as depriving (deprived-depriving) or feeling hated, and seeing others as hateful (hated-hateful) undermines enacting the scripts of childhood as an adult. Simultaneous multiple RRPs may be active and lead to complex and confusing behaviors that are grossly disadvantageous for the now fully grown child. Yet, like an addiction, the behaviors relentlessly repeat themselves in search of resolution. The notion of the behavioral script and the RRP is a powerful tool. Likewise, Ernst Hilgard's neodissociation theory, familiar to those who study hypnosis (Hilgard, 1986). The theory describes how in each of us there is an observing capacity that is somehow isolated from the main flow of consciousness. This "hidden observer" is a not-conscious reservoir of personal information that implicitly influences thought, action, and feeling. It is part of a system of multiple levels of cognitive control that may be isolated from each other, dissociated. It is part of the depth of Howell's combined traumatologist/psychoanalyst perspective that allows this kind of synthesis of related literature that has been professionally "dissociated" from psychoanalytic and traumatologic theory building. Psychoanalytic theory talks most eloquently about this influence of isolated information and psychodynamic lacunae through the theory of enactment. Howell appropriately explores the work of Bromberg, Davies and Frawley, and Stern to show how enactment is generated by dissociative process. It is the call to action by isolated, unresolved, incoherent (dissociated) fragments of experience that generates enactment and repeats the past on a modern stage with unsuspecting participants. Howell unequivocally shows the dissociative roots of enactment and the likelihood of the generation of boundary crossing and violation. As she points out, Bromberg describes the ways in which "not-me states" in both patient and analyst participate in the choreography.
Perhaps you are uncomfortable with thinking about a clinical world that does not mainly rely upon instinct, drive, and conflict? I recommend that you carefully read Howell's chapter on attachment as a way to assuage your concerns. Linking the work of Bowlby, Ainsworth, Main, and Lyons-Ruth with Bromberg and others, she matter-of-factly builds a clear case for the relative congruency of self-states and IWMs. These constructs are made from particular world views, beliefs, ideational references, associated affects and have tenacious persistence. She shows how children with disorganized attachment (Type D) have similar behaviors as compared to dissociative adults, that dissociation in adults is best predicted by the same emotional unresponsiveness as is productive of disorganized attachment, and that in longitudinal studies of Type D children it can be shown that children maintain their attachment style into adulthood. In other words, attachment theory provides a very interesting evolutionary-developmental model with massive predictive power for adult dissociative experience. Freud worked backwards from the case of the Wolfman, making connections from adult function to a reconstructed infantile neurosis. I find attachment theory and states of mind a more compelling parsimonious explication for adult behavior. Perhaps you will too, and especially so with an appreciation that you need not give up thinking about the explanatory power of intrapsychic conflict at all if you consider the inherent conflictual nature of isolated (detached, dissociated) self-states.
Howell spells out how Bowlby initially conceptualized insecure attachments as representing a full detachment of feeling and thought, in the case of avoidant attachment, and a partial disconnection in anxious-ambivalent. Both these intrapsychic maneuvers represent dissociative process. Moreover, in her discussion on splitting, Howell shows how alternation between internal working models related to the positions of Karpman's drama triangle map out the traditional inability of severely disturbed persons to reconcile and merge the "good" with the "bad" qualities of a single person (Karpman, 1968). Attachment based dissociation is a robust model of a dissociative mind.
Are there things in Dr. Howell's work that I would wish be improved and clarified? Yes, there are several, and most fall into a similar realm of the struggle to shift from a traditional Freudian psychology to one that is relational and respects dissociative process. I am referring to her efforts to find new ways to redefine repression and splitting so that the terms are not lost. I would rather she had concluded that these terms are not only archaic, but misleading, and need to become part of the rich history of psychoanalytic theory rather than continue to accrue additional meanings. After clearly showing how splitting is a concept that fails to have any particular logical developmental basis, she tries to make a case for retaining the term by reformulating the oscillations between good/bad perspectives, and the separation of this "good" from "bad" through the use of an apt attachment model that reflects contradictory behavior in a caretaker. She eventually states that the clashing internal working models in the child must be "dissociated" from each other in order to maintain attachment. While she essentially says that splitting is just a synonym for dissociation, I don't know why she doesn't just say that splitting is too general a term, too loosely used and we ought to use better terms that better describe the dissociative processes of which we are speaking. Likewise, I simply have not found a reason to continue to use the term repression. It is, for me, an historical footnote of real importance. It does not seem to have any more explanatory power about how a mind works than the term dissociation, and in fact, has much less. Is Howell trying to make the paradigm shift to including dissociative process in our formulations easier, or less threatening, by not calling for the relegation of these familiar terms, repression and splitting, to history? Maybe. Some of the same conceptual baggage shows up in an otherwise insightful reframing of projective identificatory processes as essentially dependent upon dissociative process, what she calls "blind foresight." However, this detracts minimally from the accuracy of her reframing projective processes through an implicit process lens, a shift that is overdue in our literature.
Howell's text ends with three chapters that push the envelope on understanding personality disorders, gender, and psychopathy. She shows how childhood dissociative processes neatly predict adult organizations. For example, she calls attention to the cultural sanctions that in boys facilitates the relegation of sensitivity to emotion into a disowned aspect of self, and in girls does the same with assertive and aggressive tendencies. Why is this useful? A "states of mind" model dependent upon the tension between associative and dissociative processes makes plain that the disowning of aspects of self eliminates the experience of intraspsychic conflict over, for example, aggressive wishes. If the affects associated with aggression are isolated from consciousness, then a young woman will be able to tolerate living in her traditional family without conflict with her traditional mother and father, and without a threat to patterns of attachment that preserve valued relatedness. For patient and clinician, a "states of mind" model is a solid and understandable explanation for looking at behavior that occurs, or is obviously inhibited, in a much more user friendly model than a drive model. A central goal of a treatment is to make conflict not only conscious, but possible. By working with language that fits a person's experience, for example, referring to another state as a "different way of being you," there is much less of a sense of threat than to talk about an unconscious mind where there are longings to be aggressive that have been denied and disavowed (which by the way are both dissociative processes) by mysterious unconscious processes (Chefetz, 2005).
Elizabeth Howell's book, The Dissociative Mind, is a long overdue addition to both the traumatologic and psychoanalytic literature. It has many strengths and few weaknesses. Dr. Howell's clear voice is taking its rightful place amongst the leading clinician/theoreticians of our time. I look forward to her future work, and I highly recommend this book to you as essential reading.
Bollas, C. (1987). The Shadow of the Object: Psychoanalysis of the Unthought Known. New York, Columbia University Press.
Chefetz, R. A. (2005). "A cognitive psychoanalytic perspective on the treatment of complex dissociative disorders." Psychiatric Annals 35(8): 657-665.
Davies, J. M., and Frawley, Mary G. (1994). Treating the Adult Survivor of Childhood Sexual Abuse. New York, Basic Books.
Hilgard, E. R. (1986). Divided Consciousness: Multiple controls in human thought and action. New York, John Wiley & Sons.
Karpman, S. B. (1968). "Fairy tales and script drama analysis." Transactional Analysis Bulletin 7(26): 39-43.
Putnam, F. W. (1997). Dissociation in Children and Adolescents. New York, The Guilford Press.
Ryle, A., Ed. (1999). Cognitive Analytic Therapy: Developments in Theory and Practice. New York, John Wiley & Sons.
Schore, A. N. (2003). Affect Regulation and Repair of the Self. New York, W.W. Norton & Co.
Siegel, D. J. (1999). The Developing Mind: Toward A Neurobiology of Interpersonal Experience. New York, Guilford Press.
fundamental shift July 14, 2007
9 out of 14 found this review helpful
This book is succinct and well-written by a woman with a clear, keen mind and I enjoyed it immensely. Dissociation is a subject whose time has finally arrived. I appreciated her careful inclusion of other work that is being done in this area. I hope this book will become part of a fundamental shift in understanding the human personality and how it becomes disordered by trauma. If we have people of the caliber of Elizabeth Howell working in the field of trauma, I have far more confidence that the issue won't be shoved under the table with embarrassment and fear, as has been done over and over throughout history.
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